Provider Demographics
NPI:1609224872
Name:JOO, WONSUK (DMD)
Entity type:Individual
Prefix:DR
First Name:WONSUK
Middle Name:
Last Name:JOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4045
Mailing Address - Country:US
Mailing Address - Phone:857-364-1566
Mailing Address - Fax:
Practice Address - Street 1:1242 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4045
Practice Address - Country:US
Practice Address - Phone:857-364-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857190122300000X
RIDEN03304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist